İnfertil Kadınlarda Tubal Patensi Değerlendirilmesinde Histerosalpingografi Kullanımı

Yıl 2022, Cilt: 11 Sayı: 1, 66 - 70, 29.04.2022

Özge Kahramanoğlu Sinan Güngör Fatma Ferda Verit

https://doi.org/10.47493/abantmedj.909287

Öz

Amaç: Tubal oklüzyon, kadın fertilitesinin en sık görülen sebeplerinden biridir. Tubal açıklığın değerlendirilmesinde laparoskopi altın standart iken, histerosalpingografi (HSG) de infertilite araştırmasında ilk basamak testi olarak uygulanır. Bu çalışmanın amacı, tubal patensiyi değerlendirmede HSG ve laparoskopide saptanan bulguları karşılaştırmaktır.

Gereç ve Yöntemler: Hastanemizde, Ocak 2015-Haziran 2017 tarihleri arasında primer veya sekonder infertilite nedeniyle HSG çekilen ve takiben laparoskopi yapılan hastaların dosyaları retrospektif olarak araştırıldı. Laparoskopik bulgular referans olarak kabul edilerek, HSG’nin tubal patensideki tanı gücü hesaplandı.

Bulgular: Çalışmaya toplam 67 hasta dahil edildi. Laparoskopi altın standart olarak değerlendirildiğinde, HSG’nin bilateral tubal patensiyi değerlendirmede sensitivitesi %82, spesifisitesi %75, pozitif prediktif değeri %91, negatif prediktif değeri ise %57 olarak bulundu. Aynı değerler, tubal patensi izlenmeyen hastalar için, sırasıyla, %62, %93, %55 ve %94 olarak bulundu.

Sonuç: HSG’nin, özellikle tubal patensiyi göstermede yüksek doğruluk oranına sahip olduğu bulundu. Tubal obstrüksiyon gösteren HSG’si olan kadınlarda laparoskopi kullanılmalıdır.

Anahtar Kelimeler

histerosalpingografi, laparoskopi, infertilite, tuba

Hysterosalpingography for Diagnosing Tubal Patency in Infertile Women

Öz

Objective: Tubal obstruction is one of the most common causes of female infertility. While laparoscopy (LS) is the gold standart method for assessing the patency of the tubes, hysterosalpingography (HSG) is widely used as a first-line approach in infertility work-up. The aim of this study was to compare HSG and LS in assessment of tubal patency.

Materials and Methods: Patients who underwent HSG, followed by LS for primary and secondary infertility between January 2015 and June 2017 were retrospectively analyzed. The laparoscopic findings were accepted as reference standard to calculate the diagnostic accuracy of HSG for tubal patency.

Results: A total of 67 patients were included into the analysis. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal patency were 82%, 75%, 91% and 57%, respectively. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal obstruction were 62%, 93%, 55% and 94%, respectively.

Conclusion: Our findings showed that HSG has high validity, on predicting tubal patency in particular. Laparoscopy should be used in patients with HSG showing nonpatency. 

Anahtar Kelimeler

Infertility, laparoscopy, histerosalpingograpy, tuba

Kaynakça

• Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol. 2019;133(6):e377-e384.
• Lakkawar NJ, Bora M, Rangaswamy T. A comparative study of transvaginal sonohysterosalpingography (Tv-Sh) and hystero-salpingography (HSG) for assessment of tubal patency in infertility patients. Acta Medica Medianae 2011;50:29-33.
• Maheux-Lacroix S, Boutin A, Moore L, et al. Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review with meta-analysis. Hum Reprod. 2014;29(5):953-963.
• van Rijswijk J, van Welie N, Dreyer K, et al. Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial [published online ahead of print, 2020 Jun 15]. Fertil Steril. 2020;S0015-0282(20)30298-3.
• Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44-e50.
• von Elm E, Altman DG, Egger M, et al.; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies, BMJ 2007;335:806–8.
• Swart P, Mol BW, van der Veen F, et al. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64(3):486-491.
• Foroozonfard F, Sadat Z. Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women. Nurse Midwifery Stud. 2013;2(2):188-92.
• Broeze KA, Opmeer BC, Van Geloven N, et al. Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathol-ogy? An individual patient data meta-analysis. Hum Reprod Up¬date. 2011;17(3):293-300.
• Mol BW, Collins JA, Burrows EA, et al. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 1999; 14: 1237-42.